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General NPI Number Information
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NPI Number | 1922375781
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Entity Type | Organization
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Legal Business Name | WALGREENS PHARMACY
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 561 IRVINGTON AVE
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City | NEWARK
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State | NJ
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Zip | 07106-3103
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Country | US
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Telephone | 973-373-0387
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Fax | 973-399-2614
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Provider Business Mailing Address
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Address Line | 561 IRVINGTON AVE
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City | NEWARK
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State | NJ
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Zip | 07106-3103
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Country | US
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Telephone | 973-373-0387
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Fax | 973-399-2614
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. MARIA VERONICA CRUZ CAMACHO
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Credential | PHARMD
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Telephone | 973-373-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RI03249000
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License Number State | NJ
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